Pediatric Diabetes
Type 1 Diabetes
Occurs in about 1 in 500-600 children
 Results from autoimmune destruction of
pancreatic cells that produce insulin,
resulting in permanent insulin deficiency
 Insulin regulates glucose metabolism,
which is essential for growth, activity,
wound healing, and brain function

Type 2 Diabetes
Rather than insulin deficiency, insulin
resistance occurs in T2, impairing
cellular uptake of insulin
 This can eventually lead total
destruction of pancreatic cells and thus
insulin deficiency

Blood Glucose Level

As a result of insulin deficiency, blood
glucose levels often deviate from normal
range, resulting in…
– Hyperglycemia (high blood glucose level)
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•
•
•
Too much food
Too little insulin
Illness
Stress
– Hypoglycemia (low blood glucose level)
• Too little food
• Too much insulin
• Extra exercise
Hyperglycemia: Symptoms

Extreme Thirst
 Frequent Urination
 Dry Skin
 Hunger

Blurred Vision
 Drowsiness
 Nausea
 Ketones
– Acid in blood
Hypoglycemia: Symptoms
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


Shaking
Fast Heartbeat
Sweating
Anxiety
Dizziness
Hunger

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Impaired Vision
Weakness
Fatigue
Headache
Irritability
Long Term Complications

Heart attack due to
reduced blood flow
to heart
 Stroke due to
reduce blood flow to
brain
 Loss of circulation
causing slow wound
healing

Diabetic retinopathy
caused by broken
blood vessels in eye
(loss of vision)
 Diabetic
nephropathy (kidney
damage/failure)
 Neuropathy (nerve
disease) can cause
pain, loss of feeling
Good News: Treatments

Treatment to manage blood glucose
levels
– Eat healthy foods
• Too many carbohydrates raise blood glucose
levels
– Get exercise daily
– Check blood glucose levels
– Take medications
• Different types of insulin medications
Diabetes Management
Knowledge
 Skills
 Treatment adherence

– To all parts of regimen!!!
Diabetes Assessment

Self-report instruments
– Johnson’s 24-hour Recall Interview
• Reconstruct diabetes-related events
• Conducted separately with child/parent
– Self-Care Inventory
• Completion of 14 diabetes-related tasks
– Caution of over-reporting

Direct Observation
– Meal-time Observation Schedule
– Interaction Behavior Code
• Family interactions
Diabetes Assessment

Technological Alternatives
– Memory in blood glucose meter

Family measures of functioning
– Responsibility measures
– Communication
The Psychology of Diabetes:
Risk Factors

Adherence is related to family factors
– Perceived nagging
– Conflict
– Ineffective communication

Stress may affect glycemic control and
adherence
– Patients in poor metabolic control have been
found to exhibit maladaptive ways of coping with
stress
The Psychology of Diabetes:
Risk Factors

Adolescents with T1 may be at higher
risk of eating disorders, due in part to
weight gain associated with the initiation
of insulin treatment
– Purposeful omission of insulin treatment
The Psychology of Diabetes:
Risk Factors

Degree of perceived interference in
daily life
– Management requires adherence to
multiple daily tasks at home, school, and in
other social settings

Social pressure may negatively affect
adherence
How Psychologists Can Help:
Family Factors

Supportive (but not “nagging”) parental
involvement
– Praise, warmth, encouragement, and empathy
– Appropriate for child’s maturity level
– Examples
• Gentle reminding
• Assistance in diabetes tasks
– Balance with needs for autonomy
• Gradual yielding of responsibility associated with
increased self-confidence and personal ownership of
regimen
How Psychologists Can Help:
Family Factors

Family problem solving and conflict
resolution
1.
2.
3.
4.
5.
6.
Define problem
Set a goal
Brainstorm ways to accomplish goal
Evaluate Ideas
Action plan
Revise the goal
How Psychologists Can Help:
Family Factors

Communication
– Didactic Instruction
– Feedback
– Modeling
– Behavioral Rehearsal
– Monitoring
How Psychologists Can Help:
Family Factors

Communication
– Encourage members to talk directly to one
another rather than using third parties
– “I” statements
– Decrease interruptions, yelling, namecalling, “mind reading”
– Improve non-verbal communication
• Eye contact, fidgeting, smiling
How Psychologists Can Help:
Coping with Stress

Support from health care professionals
– Encouraging, empathetic, flexible

Coping skills training for maladaptive coping
responses
– Social support
– Problem solving skills
– Cognitive restructuring
• “It’s not fair that I have diabetes and can’t eat what I
want.”

Psychotherapy for psychiatric disorders
How Psychology Can Help:
Advocate

Talk with day care/school/camp officials
to advocate for special needs
– Provide general information
– Describe child’s regimen and its potential
impact on the setting
– Identify barriers to adherence and problemsolve ways to overcome them
– Address problems that may arise
UF Telehealth Program

Family focus
– Parent-child interactions
– Positive parenting principles
– Setting reasonable goals
– Changing home environment
• Stimulus control
UF Telehealth Program

Child Focus
– Injection strategies (e.g., sliding scale)
– Blood sugar testing (e.g, watch alarm)
– Nutrition (e.g., food intake monitoring,
measuring portions)
– Communicating with medical team
– Handling high/low blood sugar levels
– Exercise (e.g., setting reasonable goals)
Treatment Effectiveness
Overall, treatments have been shown to
increase adherence
 However, not all treatments have been
proven to be effective in achieving
metabolic control
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